Medical Policies
Policies that are included in the FEP Medical Policy Manual.
The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member.
- 5.30.040 Kanuma (sebelipase alfa)
- 5.30.041 Xuriden (uridine triacetate)
- 5.30.042 Potassium Binders
- 5.30.043 HCG Powder, Novarel, Pregnyl, Ovidrel
- 5.30.044 Aldurazyme (laronidase)
- 5.30.045 Myalept (metraleptin)
- 5.30.046 Sensipar (cinacalcet)
- 5.30.047 Parsabiv (etelcalcetide)
- 5.30.048 Insulin GLP-1 Combinations
- 5.30.049 Brineura (cerliponase alfa)
- 5.30.051 Mepsevii (vestronidase alfa-vjbk)
- 5.30.052 Crysvita (burosumab-twza)
- 5.30.053 Jynarque (tolvaptan)
- 5.30.054 Samsca (tolvaptan)
- 5.30.055 Palynziq (pegvaliase-pqpz)
- 5.30.056 Orilissa (elagolix)
- 5.30.057 Galafold (migalastat)
- 5.30.058 Nocdurna Noctiva
- 5.30.059 SGLT2 Step Policy
- 5.30.060 Revcovi (elapegademase-lvlr)
- 5.30.061 Gamifant (emapalumab-lzsg)
- 5.30.062 Anabolic Steroids
- 5.30.063 Evenity (romosozumab-aqqg)
- 5.30.064 Tepezza (teprotumumab-trbw)
- 5.30.066 Isturisa (osilodrostat)
- 5.30.067 Leuprolide
- 5.30.068 Oriahnn (elagolix estradiol norethindrone)
- 5.30.069 Mycapssa (octreotide)
- 5.30.070 Dojolvi (triheptanoin)
- 5.30.071 Demser (metyrosine)
- 5.30.072 Reclast (zoledronic acid)
- 5.30.073 Sandostatin (octreotide)
- 5.30.074 Trijardy XR (empagliflozin, linagliptin, metformin)
- 5.30.075 Nulibry (fosdenopterin)
- 5.30.076 Myfembree (relugolix estradiol norethindrone)
- 5.30.077 Nexviazyme (avalglucosidase alfa-ngpt)
- 5.30.078 Kerendia (finerenone)
- 5.30.079 Voxzogo (vosoritide)
- 5.30.080 Cortrophin Gel (corticotropin)
- 5.30.081 Recorlev (levoketoconazole)
- 5.30.082 Xenpozyme (olipudase alfa-rpcp)
- 5.30.084 Tzield (teplizumab-mzwv)
- 5.30.085 Lamzede (velmanase alfa-tycv)
- 5.30.086 Antidiabetic GLP-1, GIP-GLP-1 Agonists
- 5.30.087 Elfabrio (pegunigalsidase alfa-iwxj)
- 5.30.088 Sohonos (palovarotene)
- 5.30.089 Lantidra (donislecel-jujn)
- 5.30.090 Pombiliti (cipaglucosidase alfa-atga)
- 5.30.091 Opfolda (miglustat)
- 5.30.092 Rezdiffra (resmetirom)